Nursing students work to improve the health of homeless women.
Richard Glover, SSW ’81, stands in the middle of a brightly painted common room in a North Philadelphia facility* for approximately 185 homeless women and children and holds court during a weekly community meeting. About 20 women, some with children, are seated in a circle in the room, which also is crammed with tables and chairs arranged for breakfast. The walls are adorned with nutritional posters, and an illustration of First Lady Michelle Obama encourages residents to “Eat smart!”
The women look tired—a combination of the meeting's early start time and getting little sleep the night before.
Glover, the director of this location for the past three years, holds weekly meetings to inform residents of operational issues, such as mealtimes and food allotment; allow them to voice their concerns, such as problems with heating or plumbing in their rooms; and to provide the women with financial, legal and educational resources to help them get out of the shelter and into their own homes.
Glover starts the meetings in the same way each week, by addressing each woman in the circle individually. “Tell me your name, how you're feeling and what your goal is for today.”
The women are generally soft‐spoken, and most respond with “I'm okay,” “I'm fine,” “I could be better.” Some of the women say their goal is to get more sleep. Others have more specific objectives in mind: “I need to enroll my son in daycare,” or “I need to call Social Security and get some things straightened out with my check.”
The group of women includes Temple nursing students, outfitted in maroon shirts and khaki pants, who come to the site once a week each semester. They educate the women on all manners of health issues: weight management, healthful eating, birth control. The visits, which are part of the students´ clinical curriculum, are designed to help them better understand North Philadelphia´s public‐health issues. Today, they focus on stress management.
“How many of you feel tired at the end of the day?” asks Maria Tieng, Class of 2014. Several hands go up. “Angry?” More hands. “Under pressure?” Even more hands. “Those are all results of stress,” Tieng explains. The students launch a discussion about what stress is and how it can affect one's health and well‐being. A debate ensues over the definitions of good and bad stress.
“There's nothing good about stress!” Alice** exclaims. “I don't like that terminology. You can't just say something’s good when it affects you badly.”
“I think what the students are saying is that stress can be either good or bad,” explains Terri Kelly, clinical instructor for community health and liaison between Temple and the center. “It depends on how you let it affect you.”
That steers the discussion toward stress‐management techniques, and the students lead the women in a meditation exercise. Kerri Lewis, Class of 2016, plays relaxing music while Tieng instructs the residents to close their eyes and directs them on how to breathe. For five minutes, the women look tranquil and at peace. Traces of worry vanish from their faces.
“So, how do you feel?” Tieng asks the group after the exercise.
“That meditation stuff was off the hook,” Alice says. “I don´t usually get to stop after running all over and looking after him”—she looks at her son—“to just take a minute.”
‘WE'RE NOT LAZY’
Temple's nursing students have been visiting this particular facility for three years. In addition to providing the residents with health education, they also conduct blood‐pressure screenings, take BMI (body mass index) measurements and assist with childcare.
The Department of Nursing requires its students to participate in a clinical component, through which students regularly visit various sites, such as schools, clinics and shelters. Those visits enable students to acclimate to working in real‐life settings long before graduation and apply what they have learned in the classroom in a meaningful way.
"Having nursing students here is a mutually beneficial arrangement,” Glover says.
“The residents love having them here, they talk about a number of health issues, and the students have the opportunity to learn from the residents.”
One thing the students have learned is that the women who live there are not so different from the nursing students themselves. Some are college educated, and many are around the same ages as the students.
“I was surprised at how similar I am to many of the women,” says Lewis, a sophomore. “I haven't suffered some of the hardships these women have, but I was surprised to see that they have opinions, thoughts and experiences similar to mine.”
One resident, Jane, was enrolled in the Community College of Philadelphia and held several jobs before a series of factors, including health issues, unemployment and a bad family situation, forced her onto the street with two small children.
“We're not lazy; we're not uneducated,” Jane says. “Homelessness can happen to anyone.”
“When the public thinks of ‘the homeless,’ many picture a bag lady or a drunk lying in the street,” Glover says. “Those situations are extremely rare.” Instead, he notes, the women in his shelter are victims of myriad circumstances working against them, including abject poverty.
According to the Pew Charitable Trusts' 2013 State of the City report, 28 percent of the population of Philadelphia lives below poverty level, ranking the city third highest in rates of poverty behind Detroit and Cleveland. In the neighborhood that houses Glover's site, that rate is 53 percent.
Further, Glover estimates that about 70 percent of his residents are victims of some type of domestic abuse, whether it be physical, verbal, emotional or financial. Those numbers echo a national trend: According to the National Network to End Domestic Violence, approximately 63 percent of homeless women have experienced some form of domestic violence in their adult lives.
All those factors contribute to a vicious cycle of homelessness, Glover adds. By providing health education and treatment, and financial and legal counseling, “we do our best to stop that cycle.”
CIRCLE OF LOVE
After the day's presentation on stress management, the last of the fall semester, the nursing students gather with Kelly in a separate room, for what she calls “the circle of love”—a meeting Kelly holds at the end of each visit so students can express their feelings about the day, and Kelly can provide feedback on the students' performance.
“Students do a variation of this in all their clinical settings,” she explains. “In nursing, debriefing is an essential part of the communication process.”
During today´s discussion, Alice's comments about good and bad stress are a hot topic.
“That was a little rough,” Tieng says.“ I wasn't expecting such pushback.”
“Alice is very smart and well‐read,” Kelly responds. “She likes to challenge and ask questions. I thought you guys did a great job with your teaching, by asking so many questions.”
Kelly has worked with nursing students at this center for almost two years.
“Prevention is their focus,” Kelly says.
“The students take the things they learn in a clinical setting and implement them in the community.”
For example, if a patient is diagnosed with high blood pressure, his or her healthcare provider can advise the patient to get more exercise by walking or taking his or her children to the park. But the clinician might have no idea whether the patient's neighborhood is safe or conducive to walking. Kelly says that having the students work at the shelter can help them become more aware of the needs of the community they will serve one day.
“Being here changes the idea of a nurse from someone just doling out medication and treating patients to someone who educates them and prevents health problems from occurring,” says Megan Nardi, Class of 2014. As a part of their clinical requirements, both she and Tieng had rotated through clinics and schools previously, but were unsure what role they would be able to play at a center for homeless women.
“I feel impactful at the shelter,” Tieng says. “It´s hard for these women to find out information about their health, but we can be resources for that. We talk about stress management, healthful eating, relationships, anything. It's helped me see that there is so much more to nursing.”
As the students continue their discussion with Kelly, both Alice and Jane also make appearances in the circle of love. Residents sometimes join in these meetings to talk and share their feelings—their own form of decompression.
Alice talks more about her objection to the term “good stress” and discusses her frustrations in being unable to find a job. Tieng suggests having someone review Alice's résumé. “He or she could tell you what works for employers and what doesn't,” she notes.
Jane talks briefly about starting classes to become a certified nursing assistant and her hope of getting her degree in nursing. Kelly and the students share their excitement for her and their encouragement. Bolstered by their words, Jane brightens before saying goodbye to the students as they complete the semester.
“Goodbye, my nurses, I'm gonna be there with y'all soon,” Jane says with a grin. “R.N.—hello!”
*In the interest of the residents' safety, the name and location of this facility have been withheld.
**The names of residents have been changed.